High Value Primary Care: New Evidence on the Excellent Return on Investment in Primary Care

1. High Value Primary Care: New Evidence on the Excellent Return on Investment in Primary Care Commonwealth Fund and Alliance for Health Reform Briefing December 13, 2010 Kevin Grumbach, MD Department of Family & Community Medicine University of California, San Francisco Center for Excellence in Primary Care

2. Abundant research evidence over the past 20 years indicates that health systems and regions with a strong foundation of primary care have: • Better population health outcomes • Better quality of care • More preventive care • Lower costs • More equitable care and mitigation of health disparities

3. Source: Baicker & Chandra, Health Affairs, April 7, 2004

4. Source: Baicker & Chandra, Health Affairs, April 7, 2004

5. From Observational Studies to the Health System Equivalent of Clinical Trials • What happens to quality, access and costs as a result of investments to enhance and improve primary care? • A review of recent prospective evaluation research on the outcomes of interventions to implement advanced primary care models of Patient-Centered Medical Homes in the US

6. Review of Recent Evidence on PCMH Outcomes • 14 different initiatives • >1 million patients, 1000s of medical practices • 5 Integrated delivery systems • Group Health, Geisinger, HealthPartners, Intermountain, VHA • 3 Private health plan sponsored initiatives • BCBS South Carolina, BCBS North Dakota, Metropolitan Health Networks Florida • 2 Medicaid state initiatives • North Carolina, Colorado • 4 Other models

7. Common Elements of PCMH Models • Team-based primary care • Proactive care coordination (often with RN care managers) • Enhanced patient access • Systematic chronic care model • Tracking and feedback of clinical performance data • Payment reform

8. Findings Are Consistent Across These Studies • Excellent return on investment: • Quality of care, patient experiences, care coordination, and access are demonstrably better. • Reductions in ED visits and hospitalizations produce net savings in total costs per patient.

9. Examples of Cost Outcomes • Group Health Cooperative: 5% ↓ $PMPM • Geisinger: 7% ↓ $PMPM • VA: $593 ↓ cost per patient with COPD • BCBS South Carolina: 6.5% ↓ $PMPM • Metropolitan Health Networks: 20% ↓ $ per patient • North Carolina Medicaid/SCHIP: Cumulative savings of $974.5 million over 6 years (2003-2008) • Colorado Medicaid: $215 ↓ cost per child per year

10. Conclusions • Primary care has an excellent ROI • Better quality • Bend the cost curve • With appropriate resources, primary care practices are able to transform themselves into high performing patient centered medical homes • Urgent need for all stakeholders to support reform and renewal of primary care